The truth about sex and the menopause, by a menopause doctor
Published: 17th January 2020
Dr Newson has written this informative article for The Telegraph, addressing some misconceptions surrounding sex and the menopause and why it is so important that women have access to the correct information. See the original of this article here.
The more sex you have in middle age, the later you’ll enter the menopause. That’s about the gist of recent headlines after a new study, that followed 3,000 middle aged women for a decade, found those having weekly sex went through the menopause later than those having it less than once a month.
One of the study authors, Megan Arnot, who is studying for a PhD at University College London, said of the study’s findings: “There’s a use it or lose it kind of thing going on.”
However, as a menopause doctor, I think we should take these findings with a pinch of salt. Partly because the study involved questioning women about their sex lives, which always raises the question of how truthful and accurate the answers are. And secondly because the issue of menopause and sex is such a complex one.
Rather than weekly sex delaying the menopause, it could be that women who are in the early stages of the menopause start to have less sex. And this could be for several reasons.
None of the women who took part in the study had yet entered the menopause. However, 46 per cent were beginning to experience symptoms, such as changes in their period and hot flushes, which means they were very likely to be perimenopausal, which is the transitional stage leading up to the menopause. Oestrogen and testosterone, two hormones that begin to dip as you approach the menopause and then decline as you go through it, can be very important for self esteem, self worth, weight gain, and body image. Which, as every woman knows, are very important when it comes to how much sex you feel like having.
Libido for women is a lot more complicated than it is for men. In men it's often hormonal and can be improved with testosterone replacement therapy. However, in women it usually far deeper than just a hormone deficiency. When I was perimenopausal (obliviously so, I might add) I became very irritable and even my husband’s breathing annoyed me. I know women who experience such intensely hot flushes they can’t bear their husbands to hold their hands as this can trigger them, and many women find sleep really difficult during the perimenopause and menopause. If you’re feeling hot, irritable and exhausted, you’re not going to want to have sex, are you?
The perimenopause also tends to hit right around the time you’re caring for ageing parents, holding down an increasingly stressful job, raising teenagers or young children, and have been with your other half for twenty years or so. It’s hard to pinpoint whether your lack of sex drive is hormonal, or all of the above.
So I wouldn’t want women - and men for that matter - to read the recent headlines and interpret it as the amount of sex they’re having as being a good or bad thing. Nor that it might ‘ward off’ the menopause.
The age at which you enter the menopause is largely determined by your genetics. Factors like the number of eggs you were born with, when your mother, aunts and sisters went through their menopause, whether you’ve been treated for breast cancer, or had a gynaecological cancer, like cancer of the womb or cervix, also affect the age of your menopause. Whether you have sex once a week or not isn’t going to make much difference to the age of menopause for most women.
It is usually healthier to have your menopause when you are older, because oestrogen is a health-protecting hormone. When you no longer have it your risk of type 2 diabetes, osteoporosis, heart disease, dementia and depression increases.
So the real story here, and the conversation we should be having, is that it’s important to view the menopause as female hormone deficiency and know that having low hormones levels for many years (decades for most women) is associated with health risks. We should consider replacing these hormones with hormone replacement therapy (HRT).
Too few GPs receive adequate training and education to properly manage the perimenopause and menopause. Too many women are being incorrectly diagnosed with depression because they are presenting with symptoms such as low mood, anxiety, irritability, lack of sex drive and sleep issues. A recent study showed 66 per cent of menopausal women were wrongly offered or given antidepressants. Yet antidepressants are not effective to improve the low mood associated with low hormone levels. However, studies have shown that giving these women oestrogen in HRT improves their mood.
The same goes for sex drive. I've spoken to perimenopausal women in my clinic telling me they are avoiding having sex with their partners. One lady recently told me that she would rather drink toilet water than have sex with her husbands, who she loves dearly. When women like this receive the right dose and type of HRT they often come back to my clinic and tell me their libido has improved and that sex is great again.
I see same sex couples who are both perimenopausal, which is hard as they often are both experiencing symptoms at the same time. Many men have little or no understanding of why their wives don’t want to have sex with them anymore because nobody has explained the menopause to them. So we need to start talking about sex and the menopause.
I run a private menopause clinic because I can’t get a job in the NHS due to insufficient funding for specialist menopause clinics. This needs to change. I see women from all over the country who have been quietly living with symptoms for many years. Many of these women have given up work and also left their partners because of their symptoms. Often they give up exercise because their body feels achy and tired, and they rely on alcohol to prop up their mood, yet both these lifestyle changes can exacerbate menopausal symptoms. Drinking alcohol can also lead to weight gain and increasing tiredness, which then negatively impacts on how much sex you want to have.
So rather than encouraging women to ‘have regular sex’ to delay the menopause, we should be diagnosing and treating menopausal symptoms sooner so they want to have sex in the first place.